Dental Caries (decay)
 

Am I at Risk of Dental Caries?

Yes. Unless you are edentulous; that is, you have no teeth.

There are however different degrees of risk. Everyone is at risk so there is not a 'no risk' category only:
  • High risk; you are prone to getting dental caries.
Of course the reality is there is a spectrum from 'low risk' to 'high risk'. If you answer 'yes' to some of the questions, you may be deemed a 'moderate caries risk' . These are terms that dentists commonly use, so you should be aware of them and what they actually mean.

So what makes someone 'low risk' and someone else 'high risk'?

A summary of the various things that affect your risk i.e. How prone you are to getting dental caries is shown in the diagram below.

It is important to remember:
  • Just because you are high risk for one factor, doesn't make you high risk overall, but the more of the high risk things you can say 'yes' to, the more at risk you are of getting decay.
  • Just because you are 'low risk' now, doesn't mean you always will be. If your diet and plaque control suddenly worsen, you will move along the spectrum towards 'high risk'.
  • Similarly If you are 'high risk' now, then with some positive changes, your risk and the amount of new dental cavities you get can be reduced, or even stopped.

All these risk factors are not created equal and indeed lots of them are inter-related. Most dentists would agree that diet, plaque control, fluoride and dental visitsare the key four.

The various risk factors and whether you are deemed 'low risk' or 'high risk' will determine how often screening X-rays are taken by your dentist.

If your Dentist fills all the Problem Cavities, am I still at Risk of Dental Caries?

Yes. If your environment and the reasons that led to you getting problems in the first place e.g. poor hygiene and a high sugar diet haven't changed, then the chances are, you are in for some more dental treatment- unless your habits change. Preventative treatment is always needed in addition to the drilling and filling, to reduce the chance of further problems happening. That's what we are discussing here.

By the end of this section and with the advice in our Prevention Section , you will understand why you get cavities; how they form and what you need to do to stop them. The key is really in the action you take, so read it, understand it and most importantly DO IT.

What affects my Risk to Dental Caries

Summary:


Various risk factors of decay
Various risk factors of decay


As a dentist, when we are assessing your risk of getting dental caries (dental decay) we look at many factors, here is a slightly expanded list:
  • Medical history
High risk:
Learning difficulties
Physically compromised
Medically compromised
Sugared medicine.

Low risk:
No medical or physical problems that affect the ability to perfom hygiene procedures.
  • Social Background
High risk:
Socially deprived
Low education
Low income
Single parent families
Family dental history of problems (parents and siblings).
  • Age
High risk:
Young- immature enamel and vulnerable teeth
Old- age related factors such as recession, poor saliva flow, many restorations, difficulty cleaning, partial dentures etc. and changes to the diet put you more at risk in your most senior years.

Low risk:
Adult- as you get older and learn about taking responsibility yourself for your diet and hygiene things typically improve into adulthood.
  • Teeth
High risk:
Deep pits and fissures in the patterns of your back teeth
Awkwardly positioned teeth that make cleaning difficult
Lots of root surfaces exposed
Poorly formed teeth
Genetically weak teeth.

Low risk:
Shallow easy to clean pits and fissures or fissure sealed teeth.
  • Dental work
High Risk:
Many fillings/restorations
Missing teeth
Premature extractions
Frequent new dental caries
Caries in easy to clean places such as the front of the mouth
Dental caries around previous fillings
Dental caries in 1st permanent molars between 6 and 8 years old.

Low risk:
Few fillings/ restorations
No missing teeth (wisdom teeth don't count)
No new dental caries.
  • Saliva
High risk:
Little or no flow (xerostomia/dry mouth)
Poor quality saliva (little buffering capacity).

Low risk:
Good normal flow
  • Dental recalls
High risk:
Irregular visits
Go only in pain/ rarely for check-ups and cleaning.

Low Risk:
Attend regularly for 6 monthly check ups.
  • Dental appliances
High risk:
Wear dental braces
Have partial dentures

Low risk:
No dental appliances.
  • Diet
High risk:
Poor diet
Frequent sugary intakes of food and drinks
Frequent snacking.

Low risk:
Good healthy diet
Few sugary intakes and food and drink.
  • Plaque control
High Risk:
Little effective toothbrushing
No regular flossing/cleaning in between teeth


Low risk:
Good regular toothbrushing
Good regular flossing/ cleaning in between teeth.
  • Fluoride
High risk:
No/ little fluoride in the water
No fluoride supplements
No fluoride toothpaste.

Low Risk:
Fluoridated water supply
Using a fluoride toothpaste

Ingredients for Dental Caries?

Let's look at another diagram to cement our understanding of what influences dental decay and how the different factors interact:
Caries venn diagram
Caries venn diagram


Factors influencing dental decay; 'Keyes and Jordan diagram'

Explaining the Diagram:

There are three levels to the diagram and so to the caries equation:

Level one:

Three things are needed for dental caries to occur:
  • Plaque (bacteria)
  • Tooth
  • Diet (sugar)

When you have all three together, you have the necessary ingredients for making a cavity. Take one away i.e. where you see only two of them overlapping and dental caries will not occur. But that is not the full story...

Level two:

There is a second layer of factors that directly and significantly affect your susceptibility to dental decay:
  • Time
  • Saliva
  • Immune system
  • Topical fluoride

Level three:

In the third level, we have a number of circumstances that influence positively or negatively the likelihood of getting dental caries:
  • Education
  • Socio-economic status
  • Income
  • Knowledge
  • Attitude
  • Behaviour

How the diagram works:

If a risk factor is high in level one, then the size of that particular circle increases. This creates additional overlap (a bigger red area) demonstrating that the risk of developing caries is increased.

For example, if the diet is very high in sugar, this would make that circle much larger and so the chance of caries much greater. The result is:

Caries diagram showing high-sugar diet
Caries diagram showing high-sugar diet



Hope that makes sense.